Clinical remarks on acute post-traumatic atlanto-axial rotatory subluxation in pediatric-aged patients

Objective: This study aimed to identify specific findings related to acute post-traumatic atlanto-axial rotatory subluxation in pediatric patients.

Methods: We studied 14 children with acute atlanto-axial rotatory subluxations after a craniocervical injury admitted to a hospital during a 6-year period. Clinical and radiologic findings were reviewed to identify new findings related to atlanto-axial rotatory subluxation.

Results: Most patients exhibited a typical picture of atlanto-axial rotatory subluxation, but 1 child also experienced transient blindness that was related to peculiar anatomic findings on neuroradiologic images. A characteristic C2-C3 anterior pseudosubluxation was detected among the radiographic signs. Magnetic resonance imaging showed no clear break in the alar ligaments, which were oriented horizontally. However, unlike the case in adult anatomy, in these children, the alar ligaments were laterally attached at the occipital condyle-axis condylar joints. In all children, atlanto-axial rotatory subluxation spontaneously reduced within a few hours after short bed rest without halter traction but with a cervical collar. No recurrence was observed during follow-up.

Conclusions: Acute post-traumatic atlanto-axial rotatory subluxation in pediatric-aged patients is a rapidly resolving disease of the craniocervical junction. The disease appears to be related to an elasticity of the contralateral alar ligament, which is attached to the occipital condyle-axis condylar joint. Neurological symptoms (blindness) occurred in 1 patient when the vertebrobasilar blood flow was impaired and no compensation was provided from the anterior circulation. Use of a cervical collar and short bed rest without halter traction is recommended, based on our observations of complete recovery and no recurrence after the use of this treatment strategy.